Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease

Abstract

Kawasaki disease is generally known as a systemic vasculitis that often concerns doctors due to its serious cardiac complications; however, other visceral organs may get involved as well. Surgical manifestations of the intestinal tract in Kawasaki disease are rare. In this report, we describe the case of a 2.5-year-old boy with typical Kawasaki disease who presented with GI bleeding and surgical abdomen. The diagnosis of duodenal perforation was confirmed.

Intestinal Involvement in Kawasaki Disease

“…Plain radiograph, ultrasonography, and computed tomography (CT) showed pseudoobstruction as the most frequent sign of gastrointestinal involvement (multiple dilated intestinal loops with multiple fluid and gas levels and/or concentric thickening of the intestinal wall) in 38 cases (77%). [2][3][4][5][6]8,9,[12][13][14][15][16][17][19][20][21][22][23][27][28][29][30][31][32][33] However, pseudoobstruction was accompanied by ischemic colitis in 1 case (2%), 4 hydrops of the gallbladder in 1 case (2%), 6 mesenteric and splenic ischemia 28 in 1 case (2%), hemorrhagic duodenitis 15 in 2 cases (4%), and appendicular involvement in 10 cases (20%). 15,21,25,27,28 Only 1 case showed mechanical obstruction with intussusception, 24 and 1 patient whose radiograph showed presence of free subdiaphragmatic intraperitoneal air developed a perforated ulcer in the descending duodenum.…”

“…15,21,25,27,28 Only 1 case showed mechanical obstruction with intussusception, 24 and 1 patient whose radiograph showed presence of free subdiaphragmatic intraperitoneal air developed a perforated ulcer in the descending duodenum. 29 Regarding surgical procedures, 25 (51%) patients underwent surgery, 5 (10%) underwent exploratory laparotomy, 2,8,15,29,30 8 (16%) required resection of the restricted loop and temporary colostomy, 3,6,9,12,14,23,28,32 and 1 (2%) required enterolysis. 4 Endoscopy for hematemesis was performed in 2 cases (4%).…”

“…4 Endoscopy for hematemesis was performed in 2 cases (4%). 15,29 Cardiac involvement was documented in 21 (43%) of the cases considered. [3][4][5][6]9,[12][13][14][15][16][20][21][22][23]27,28,31,32 All patients except 3 2,3 received medical treatment: 12 patients (25%) were administered immunoglobulin intravenous (IGIV) alone, and 18 patients (37%) were administered IGIV with aspirin.…”

“…2,5,13,16,17,[20][21][22]24,33 The outcome was good in 28 patients (57%, including the 3 patients who did not receive medical treatment). 4,6,12,17,19,[21][22][23][24]27,[29][30][31][32][33][34] Seven patients (14%) showed persistence of CAAs, 5,15,16,20,21 and 1 (2%) patient developed cyanosis, and later, left hand and forefoot gangrene. 3 Three patients (6%) died: in 1 case autopsy revealed massive liver necrosis and progressive duodenal infarction with systemic arteritis and periarteritis involving vessels of all sizes 3 ; the second patient died 2 days after the exploratory laparotomy 2 ; the third patient died because of Pseudomonas septic shock.…”

A case of Kawasaki disease presenting as sigmoid colitis

“…Gastrointestinal symptoms including diarrhea and vomiting are relatively common findings. As specific abdominal complications, intestinal pseudo-obstruction [ 1 , 2 ], hydrops of the gallbladder [ 3 ], pancreatitis [ 4 ], duodenitis and duodenal perforation [ 3 , 5 ], and appendicitis [ 3 , 6 ] have been reported. Gastrointestinal symptoms often obscure the correct diagnosis of KD in cases that do not fulfill sufficient diagnostic criteria for KD.…”